Tools to Improve Patient Engagement in Value-Based Care

With the advent of a shift to value-based care and increasing accountability for effective care, patient engagement is emerging as the primary mechanism to effect change. However, the sheer volume of patients means that physicians and nurses cannot hope to touch them every day in the meaningful ways needed to fully engage each patient. Technology solutions must rise to the occasion.

Linda D. Bosserman, MD, FACP, Medical Oncology and Hematology, City of Hope Medical Group, Rancho Cucamonga, CA, led a panel discussion on the use of technology to enable patient engagement at the 2017 Cancer Center Business Summit. The panelists shared information on specific tools and solutions that could help practices to meet their goals for better engagement with patients.

Engaging Patients in Their Care

Deirdre Saulet, PhD, Senior Consultant, The Advisory Board Company, Washington, DC, said that patient engagement frequently arises among its 1300 hospital centers across the country as a major concern and strategy. There are multiple reasons to elevate the patient role, each with benefits from improved patient activation:

Decreased costs:
Patient activation has repeatedly been shown to reduce overall costs, and can help to prevent avoidable emergency visits and hospitalizations

Enhanced patient experience:
Value-based programs include evaluations based on patient satisfaction. Higher patient engagement can help differentiate programs with high satisfaction survey scores, and can yield potential future increases in reimbursement through top-tier scores

Increased patient loyalty:
Better patient engagement can reduce the outmigration of dissatisfied patients, and programs that encourage satisfied, engaged patients will also meet the needs of new cancer care consumers.

Engaging patients across the cancer continuum can be challenging and resource intensive. Patients have questions and need general and targeted education throughout their journey. Solutions need to address the realities that not all staff members may be available or prepared to answer all questions. The questions that patients ask will change over time, and often patients may be embarrassed to ask questions, or may not want to be perceived as difficult or bothersome. According to Dr Saulet, their clients have found that a real “challenge for providers is to track their patients, to make sure the right information is delivered at the right time, to the right patients, when they need it.”

Several enterprising organizations are starting to see some success with unique programs. Thomas Jefferson University’s Center for Health Decisions created its Decision Counseling Program, which helps patients understand their treatment choices, identify personalized pros and cons of each treatment alternative, and then generate a treatment plan and summary that helps them become engaged, clarify their treatment preferences, and discuss their options with their clinical team. Already, 83% of the Decision Counseling Program patient participants with low-risk prostate cancer elected active surveillance rather than aggressive treatment.

The Centers for Medicare & Medicaid Services is launching 2 Medicare pilot programs to reward and support direct decision support and shared decision-making models.

Patient distress on many levels (emotional, spiritual, practical, psychological, social, and physical) can be barriers for communicating patient concerns. The Advisory Board Company has developed the Distress Screening Playbook to help its members identify resources and steps to create their own programs for distress screening.1 Guided self-reporting can provide ease of use, improved communication, better understanding of key issues, and lead to decreased symptom distress for patients.

Using Technology to Engage Patients

Technology solutions are rapidly expanding patient engagement. Dr Saulet mentioned a project at the University of Michigan that allows patients with breast cancer to enter their diagnosis and treatment information, and receive education, instructions, support, and self-care and exercise recommendations through their smartphone.

Another collaboration between Apple and M.D. Anderson Cancer Center provides patients with breast cancer with Apple watches that collect data on physical activity, patient-reported symptoms, distress, and sleep patterns, and then provide the clinical care team with dashboards, data, and alerts. Patients enjoy their own dashboards and summaries of physical and behavioral health.

Opportunities for engaging patients can occur at patient intake, personalized patient education and self-care instructions, prompts and alerts regarding medications, reporting of side effects and symptoms, and the development and delivery of care and survivorship plans.

Chemotherapy teaching is traditionally a 1-hour session provided at a time when patients can be easily overwhelmed with all of the latest news. Technology, such as the Navigating Cancer program, can be leveraged to parse consistent information on how to understand the disease, what to expect, and what medications and treatments are involved. Patients can receive or seek information at varying times as they move through their cancer journey, to help them better understand what to expect, how they can manage expectations and self-care, and when to call their physician

Triage and telemedicine needs result from the sheer volume of patient calls that can come into a cancer office while nurses and staff are engaged in active patient treatment. There is great variation as to when patient calls are able to be returned, and patients may be calling with time-sensitive symptoms and care needs. Navigating Cancer is collaborating with one office to better understand that variation and the resultant risk. Of approximately 2000 patients, 22% reported receiving a return call in <30 minutes, 42% in 1 to 2 hours, 17% in 3 to 4 hours, and 19% after >4 hours. In this example, approximately 78% of patients received a return call in >1 hour, and could be at risk for hospitalization if their symptoms progressed while waiting to hear back from the office. Better management of incoming calls and pre-emptive symptom reporting through technology could improve staff efficiency, and could reduce costs and care complications by addressing issues earlier and bringing patients into the office faster for symptom management

Remote monitoring tools to manage oral adherence, report and manage symptoms and side effects, and manage depression and pain can improve patient engagement and satisfaction. Mobile apps can be used by patients to indicate if they are taking their medications and to submit symptoms and side effects, and can be tailored to increase prompts to patients who may be classified as higher risk.

Lessons Learned

Ms Cook concluded her discussion with a review of lessons they have learned regarding patient engagement. First and foremost, she advised that we need to think beyond the electronic medical record. Technology solutions that can solve these new patient engagement needs have to be easy for patients to use, and have to make the transitions for patients across their journey more transparent and memorable; this process needs to be automated to achieve the scalability required to assist all patients in a timely manner.

Dr Bosserman also discussed a practice that provides tablets in all areas of their clinic (ie, in the waiting area and in examination and treatment rooms) that include education as well as entertainment and inspiration. Future uses for this technology platform could include expansion into screening for clinical trials, improving awareness of clinical trial options, and recruitment for clinical trials.

Overall, the panel participants encourage cancer centers to elevate the role of patients to succeed in the growing value-based consumer markets. Patients with cancer are increasingly savvier, but they still can feel overwhelmed and may need help at many points over time with education, coping mechanisms, decision-making, and empowerment.

There are a growing number of technology tools and solutions that can be tapped, for various program levels, which are going to be essential, because the sheer ratio of patient needs to providers means that we absolutely require new ways to engage patients inside and outside of the office.

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